Résumé :
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[BDSP. Notice produite par INIST-CNRS 8R0x989k. Diffusion soumise à autorisation]. The long-term benefits of antenatal iron supplementation in child survival are not known. In 1999-2001,4,926 pregnant women in rural Nepal participated in a cluster-randomized, double-masked, controlled trial involving 4 alternative combinations of micronutrient supplements, each containing vitamin A. The authors examined the impact on birth weight and early infant mortality in comparison with controls, who received vitamin A only. They followed the surviving offspring of these women at approximately age 7 years to study effects of in utero supplementation on survival. Of 4,130 livebirths, 209 infants died in the first 3 months and 8 were lost to follow-up. Of those remaining, 3,761 were followed, 150 died between ages 3 months and 7 years, and 152 were lost to follow-up. Mortality rates per 1,000 child-years from birth to age 7 years differed by maternal supplementation group, as follows : folic acid, 13.4 ; folic acid-iron, 10.3 ; folic acid-iron-zinc, 12.0 ; multiple micronutrients ; 14.0 ; and controls, 15.2. Hazard ratios were 0.90 (95% confidence interval (CI) : 0.65,1.22), 0.69 (95% CI : 0.49,0.99), 0.80 (95% CI : 0.58,1.11), and 0.93 (95% CI : 0.66,1.31), respectively, in the 4 supplementation groups. Maternal iron-folic acid supplementation reduced mortality among these children by 31% between birth and age 7 years. These results provide additional motivation for strengthening antenatal iron-folic acid programs.
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